Significance of Best Spirometry in the First Year After Bilateral Lung Transplantation: Association With 3-Year Outcomes

Abstract

Background. Spirometry is the cornerstone of monitoring allograft function after lung transplantation (LT). We sought to determine the association of variables on best spirometry during the first year after bilateral LT with 3-year posttransplant survival. Methods. We reviewed charts of patients who survived at least 3 months after bilateral LT (n = 157; age ± SD: 54 ± 13 y, male:female = 91:66). Best spirometry was calculated as the average of 2 highest measurements at least 3 weeks apart during the first year. Airway obstruction was defined as forced expiratory volume in 1-second (FEV 1 )/forced vital capacity (FVC) ratio <0.7. Survival was compared based on the ventilatory defect and among groups based on the best FEV 1 and FVC measurements (>80%, 60%–80%, and <60% predicted). Primary outcome was 3-year survival. Results. Overall, 3-year survival was 67% (n = 106). Obstructive defect was uncommon (7%) and did not have an association with 3-year survival (72% versus 67%, P = 0.7). Although one-half patients achieved an FVC>80% predicted (49%), 1 in 5 (19%) remained below 60% predicted. Irrespective of the type of ventilatory defect, survival worsened as the best FVC (% predicted) got lower (>80: 80.8%; 60–80: 63.3%; <60: 40%; P < 0.001). On multivariate logistic regression analysis, after adjusting for age, gender, transplant indication, and annual bronchoscopy findings, best FVC (% predicted) during the first year after LT was independently associated with 3-year survival. Conclusions. A significant proportion of bilateral LT patients do not achieve FVC>80% predicted. Although the type of ventilatory defect on best spirometry does not predict survival, failure to achieve FVC>80% predicted during the first year was independently associated with 3-year mortality.

COVID‐19 in lung transplant recipients: an overview of the Swedish national experience

“…Re‐Tx is also more commonly performed as a single LTx, which is associated with a lower PFT. A suboptimal pulmonary function has been associated with worse outcomes for both COVID‐19 [ 20 ] in general and after lung transplantation [ 21 ]. Thus, one could hypothesize that low PFT pre‐COVID‐19 would be a risk factor for death.…”

Number of Bronchoscopic Interventions in Lung Transplant Recipients Correlates with Respiratory Function Assessed by Pulmonary Function Tests

“…Spirometry is considered to be the cornerstone of graft function monitoring [ 3 ]. Our study revealed that in patients who required ≥1 BI during their first post-transplant year, spirometry parameters were statistically significantly lower than in patients who did not need such bronchoscopic treatment.…”

“…That is supported by a paper published by Shofer et al [ 7 ]. In contrast, Mohanka et al found that failure to achieve FVC ≥80% was an independent risk factor for 3-year mortality [ 3 ].…”

“…The procedure also is associated with improved pulmonary function and exercise capacity [ 2 ]. However, a significant number of double-lung recipients do not achieve 80% of predicted forced vital capacity (FVC) during their first post-transplant year [ 3 ]. In some cases, the finding can be explained by a ventilatory defect caused by airway complications located in bronchial anastomoses [ 4 , 5 ].…”

Commentary: Ten-year survival, the holy grail in lung transplantation

“…For example, there is growing evidence that trends in spirometry post-transplant are associated with long-term survival. 6,7 However, there is limited knowledge of how factors such as donor smoking, size mismatch, and gastroesophageal reflux disease affect spirometry trends. To better evaluate these dynamic post-transplant variables, individual center data may provide a more granular approach compared with large databases.…”